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Paxil Alternatives
That was quite a read on Testosterone and Neurotransmitters, Doc. My wife and I take Paxil, 20 mg per day. I wonder if it causes akathisia because I toss and turn a lot, have restless leg syndrome, and irritibility. Can I suggest an alternative to my M.D.? Like what? The wife has tried alternatives because of increased appetite but they make her feel awful. Any suggestions? Thanks
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Akathisia is a motor movement disorder I hypothesize occurs when dopamine levels in the brain become too low. Manifestations include fidgetiness, restlessness, tossing and turning in bed, restless legs, irritability, anxiety, insomnia, agitation, anger outbursts, a feeling of wanting to jump out of one's skin, a feeling of ants in one's pants. It can cause worsening of the illness being treated. At the extreme, it can increase violent behavior, raise the likelihood of a suicide attempt - as a way to escape extreme discomfort due to akathisia.
Akathisia is an important side effect to watch for with medications that raise serotonin levels because raising serotonin will simultaneously reduce dopamine levels. I use it as the sign that the serotonergic medication is at an excessively high dose. I instruct patients to automatically reduce the dose of their medication if they think akathisia is occurring.
Reducing the dose often relieves the person of Akathisia. The lower dose is the optimal dose, then, for that particular medication. If depression or whatever target symptoms still persists - though reduced by the original medication - I will consider additional medications - which use different mechanisms of action - to add to the treatment to try and achieve a fuller response - such as a lower severity of depression.
When a partial response to an antidepressant occurs, I also consider if there are other, undiagnosed underlying conditions which can be targetted in treatment, which contribute to the development of the mental illness.
Paxil works by increasing serotonin levels in the brain.
Alternative medications that primarily raise serotonin levels include Prozac, Zoloft, Luvox, Celexa, Lexapro, Effexor (at doses < 150 mg/day). Medications that increase serotonin and norepinephrine include the tricyclic antidepressants (e.g. Elavil, Nortriptyline), Cymbalta, Remeron.